Figure 3.

A heat map showing how biomolecules, the gut microbiome, diet, disease, and external factors (e.g., chemotherapy and ionizing radiation) can alter sphingolipid metabolism. When in balance, bone tissue function and structure are maintained. However, when sphingolipid levels, including sphingomyelin, ceramide, aSMase, and S1P, are either up- or downregulated, this can result in, for example, osteoporosis, fragility fractures, inflammation, Paget’s disease, osteoarthritis, rheumatoid arthritis, and spondyloarthritis.